Individual
DR. PHILLIPS S WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
716 WATTS AVENUE, PASCAGOULA, MS 39567
(228) 762-5561
Mailing address
PO BOX 654, PASCAGOULA, MS 39568
(228) 762-5561
(228) 762-0313
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
155773
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00062943
—
MS
Enumeration date
10/23/2006
Last updated
07/08/2007
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